Resident Physicians as Champions in Preventing Device-Associated Infections

Preamble

This toolkit was prepared to help physicians in training (a.k.a. resident physicians) improve their approach when evaluating the infectious risk of and need for invasive devices in the hospital. The devices addressed include central and peripheral venous catheters, urinary catheters, and ventilators. We hope it will be used to guide quality improvement efforts at facilities with physician training programs. The toolkit underscores the importance of resident physicians as champions for safety efforts, particularly device safety. Because CAUTI is effectively addressed in the context of general device safety, an overview of common devices and safety issues is provided in the first sections. Although the toolkit provides a frame to “optimize venous catheter, urinary catheter, and ventilator use,” it is not meant to replace policies or guidelines related to the topic.

Intended Audience

Resident physicians

Purpose

Define an approach to evaluate the infectious risk and need for invasive devices in hospitalized patients

Learning Objectives

By the end of this learning activity, participants will be able to—

1. Summarize complications associated with the use of invasive devices
2. Describe the impact of the role of the patient safety champion
3. Explain the benefits of incorporating device safety practices in the workflow of the resident physician

Directions for Use

This toolkit can be used as a self-learning module or as an adjunct to existing educational or orientation programs. Contained within this toolkit are curricula, short case studies, a checklist, and a pocket guide.

Summary

Invasive devices are commonly used in the hospital setting. Patients are exposed to them as soon as they reach the emergency department (ED). Nationally, peripheral venous catheters (PVCs) are used in up to 90 percent of patients, and central venous catheter (CVC) use averages 35–50 percent of intensive care unit (ICU) and 10–20 percent of non-ICU patients based on unit type. The average use of urinary catheters (UCs) in adults varies between 50 and 80 percent of ICU patients and between 12 and 24 percent of non-ICU patients.  Finally, 25–45 percent of ICU patients are on ventilator support, depending on unit type. The risk of infection starts at the time of exposure to the device and continues until after removal. The risk of device-associated infection is mitigated by using the devices only when necessary, complying with appropriate use and proper device placement and maintenance, and removing promptly when no longer necessary.

Resident physicians (RPs) are an integral part of the clinical team in an academic setting. They are often the first physician responder to clinical situations and the most informed physicians regarding device presence and use.  We present a plan to help teams that include RPs address risks related to invasive devices in the hospital setting, with a focus on reducing central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated complications (VACs) including pneumonia. We also describe different approaches that RPs may choose to improve the care on their units and encourage other health care workers to adopt best practices. Each facility/unit may have special characteristics, and the implementation of the process needs to be in harmony with the existing work structure. The long-term goal is to have a safer process that is integrated into the RP’s daily routine.